Knowledge and Anxiety for Dental Treatments Due to COVID-19 among General Public.

Introduction: The fears, anxiety, and worries created among general population by COVID-19 are severe. The procedures which generate aerosols transmit most of COVID-19 transmission and we know one such procedure is dental treatment. After the COVID-19 pandemic, there is a change in health-care services; hence, this droplet transmission in dentistry became an issue which needs to be addressed. Methodology: A descriptive, online questionnaire survey was conducted among adults above 20 years. The questionnaire consisted of demographic details and questions related to anxiety and fear of considering dental treatment during this pandemic situation.
Results: 680 people responded for the study, among which 32% had COVID symptoms. 27% of them said that they are afraid of dental treatment during the pandemic whereas 47% said that they will accept if there is an emergency. The main reason for this fear was droplet infection in dental clinics.
Conclusion: The fear of dental treatment during pandemic is moderate. This may be due to the self-care, positive behavior toward oral care by the people, and fear of cross-contamination due to airborne infections though the personal protective measures were followed. Copyright:

INTRODUCTION

The WHO declared COVID-19 infection as a pandemic on the March 11, 2020.[1] That increased the efforts to increase the awareness regarding the infection signs, symptoms, mode of transmission, and prevention of COVID-19. The mass media was the main communication channel, which constantly updated information regarding newly infected cases, deaths, and recoveries.[2] This led to increased fears, anxiety, and worries among the general population. Droplet transmission from person to person within 1-m distance is the main source of spread, which was possible under specific circumstances and settings which generate aerosols.[3] Dental treatment is one such setting where various procedures involve the use of equipment that can generate aerosols. These aerosols containing microorganisms remain suspended in air in the work environment and potentially transfer to the working staff and/or patients attending the dental clinics.[12]

Hence, the awareness regarding droplet transmission of COVID-19 can influence the fear, worry, and anxiety in dental treatment seeking patients. Hence, it is important to know the pattern and address the same among general public.

METHODOLOGY

A descriptive, cross-sectional study was conducted among adults above 20 years of age in an online mode, and the ethical committee permission from College of Dentistry, Prince Sattam Bin Abdul-Aziz University was obtained. The questionnaire consisted of demographic characteristics and questions related to anxiety and fear of considering dental treatment during this pandemic situation were asked. The questionnaire was sent using digital media and Google Forms. The participants who gave response voluntarily were included. The questionnaire was both in Arabic and English language. It was sent using digital platform using WhatsApp, Snapchat, and Google Forms. Subjects were asked to fill the questionnaire and resend without discussing with anyone.

Sample size

Sample size was estimated using the formula:

n = N/1+Ne2

where

n = sample size

N = total population = 300000 mv

e = margin of error was kept at 4%

n = 300000/1 + 300000 × 0.04 × 0.04

n = 300000/481

n = 623 samples were found to be sufficient.

700 questionnaires were sent, out of which 682 were finally considered for analysis.

Validation of questionnaire

The questionnaire was validated by preparing initially in English and then translated to Arabic. After assessment and few corrections, it was translated back again to English.

Method

The questionnaire was sent to individuals using digital platforms such as WhatsApp and Snapchat along with consent form and explanation regarding the study.

Statistical analysis

The data were computed and Chi-square test with 95% confidence interval, and P < 0.05 was considered statistically significant.

RESULTS

Table 1 depicts demographic characteristics of the study population. There were a total of 280 males and 402 females, and majority of the subjects were belonging to 21–30 years of age group (33.9%). 43.5% of the subjects were having a family income of >12000 Saudi Arabian Riyal (SAR). 70.5% of the study subjects were having education up to college/degree. Figure 1 depicts 32% of study participants had COVID 19 symptoms.

Table 1

Demographic characteristics of the study population (n=349)

Demographics	Frequency, n (%)
Gender
Male	280 (41.1)
Female	402 (58.9)
Age group (years)
<20	99 (14.5)
21-30	231 (33.9)
31-40	164 (24.0)
>40	188 (27.6)
Income
<4000	70 (10.3)
4000-8000	131 (19.2)
8000-12,000	184 (27.0)
>12,000	297 (43.5)
Education
Illiterate	15 (2.2)
Up to primary	168 (24.6)
Up to middle	18 (2.6)
Up to college/degree	481 (70.5)

Figure 1

Percentage of study subjects who had symptoms of COVID-19 disease

Table 2 shows subjects' response toward anxiety and dental treatment. 40% of the subjects said that they are calm, but 27% mentioned that they are still anxious during COVID period for dental treatment. 35.5% of the subjects were undergone dental treatment during that period. 30.2% of them said that they will accept if dentist appointment is scheduled during quarantine, whereas 47% said that they will accept if only emergency is there. 59% of the subjects gave the reason as risk of contaminating them and family from the patient or employees for fearing for dental care. 59% of the subjects said quarantine effects by delaying the treatment. Moreover, they considered personal protective equipment (PPE) (40%), N95 mask to change after every patient (27%), avoid crossing with other patients in waiting room (16.3%), alcohol gel at the reception (11%), and disposable lab coat for dentists (5.6%).

Table 2

Response of study subjects to questions related to anxiety and dental treatment

Demographics	Frequency (%)
Considering the anxiety level, how are you feeling about the dental treatment during quarantine and pandemic period?
Anxious	184 (27.0)
Calm	272 (39.9)
Fear	123 (18.0)
Indifferent	93 (13.6)
panic	10 (1.5)
Did you get dental treatment during the pandemic?
No	440 (64.5)
Esthetic	32 (4.7)
prosthetic	44 (6.5)
Endodontic	116 (17.0)
orthodontic	50 (7.3)
If your dentist schedule appointment during quarantine, would you accept?
Yes	206 (30.2)
No	155 (22.7)
Yes only in case of emergency	321 (47.1)
Your opinion, what is so worrying about dental care during the pandemic?
Dentists represent high risk	38 (5.6)
My treatment is not urgent	60 (8.8)
No Concern	183 (26.8)
Risk of contaminating myself and family from the patient or employees	401 (58.8)
What do you think how quarantine effects on current dental treatment
I am afraid of losing my investments made/situation may get worse	49 (7.2)
I am not worried	231 (33.9)
It will delay the treatment	402 (58.9)
What is important in the actual stage of pandemic in dental office
Alcohol gel at the reception for patients	75 (11.0)
Crossing with other patients in waiting room	111 (16.3)
Disposable lab coat for dentists after every patient	38 (5.6)
N95 mask for dentists changed after every patient	187 (27.4)
Personal protective equipment (mask, foot, and disposable lab coat)	271 (39.7)

Table 3 shows comparison of various factors with other factors. Anxiety level during quarantine was highly significant with age and gender along with getting dental treatment. No significant difference was observed regarding dentist appointment schedule and factors worrying for it with age, income, and education. Age and gender had a significant role in effects of current dental treatment during COVID period. However, the opinions for the importance during actual stage of pandemic in dental office showed non-significant difference among age, gender, income, and education.

Table 3

Comparison of various questions according to demographic characters

Demographics	χ2, P
	Age	Gender	Income	Education
Considering the anxiety level, how are you feeling about the dental treatment during quarantine and pandemic period?	0.94, <0.001 (HS)	23.09, <0.001 (HS)	21.04, 0.052 (NS)	23.21, 0.026 (S)
Did you get dental treatment during the pandemic?	49.33, <0.001 (HS)	22.88, <0.001 (HS)	11.52, 0.48 (NS)	5.88, 0.922 (NS)
If your dentist schedule appointment during quarantine, would you accept?	7.03, 0.31 (NS)	14.73, 0.001 (S)	8.49, 0.20 (NS)	9.64, 0.141 (NS)
Your opinion, what is so worrying about dental care during the pandemic?	6.96, 0.64 (NS)	13.27, 0.004 (S)	14.62, 0.102 (NS)	10.20, 0.334 (NS)
What do you think how quarantine effects on current dental treatment	21.82, 0.001 (S)	9.74, 0.008 (S)	1.69, 0.94 (NS)	6.78, 0.342 (NS)
What is important in the actual stage of pandemic in dental office	12.63, 0.39 (NS)	8.15, 0.086 (NS)	9.70, 0.64 (NS)	13.27, 0.349 (NS)

S: Significant, NS: Non significant, HS: Highly significant

DISCUSSION

In this study, subjects showed that each dental treatment activity had different levels of fears similar to the study by Burhanuddin where approximately 38.2% of subjects felt “afraid” to get dental treatment using bur.[1] This was mainly due to high level of fear in this procedure can be attributed to the transmission of coronavirus through aerosols and other bodily fluids. Dental procedures performed using a handpiece accompanied by irrigation producing aerosols containing saliva, blood, or other secretions are high risk procedures.[345] Among the questions about the level of fear during the COVID-19 pandemic for dental procedures, the answer “fear enough” was the answer most chosen by the study subjects similar to the study conducted by Burhanuddin.[1]

“Self-medication” was the measure taken to overcome the dental and mouth problems they experienced during the pandemic COVID-19. This is from the results of Basic Health Research in Indonesia[1] where dental health problems were noted in 57.6%, out of which 42.2% choose to do self-medication. Of 68.9% of the population of South Sulawesi who had dental health problems, 38.8% choose to do the treatment yourself.[6] This shows that during pandemic, public awareness as well as fear to get dental treatment was more.

The results of the present study identified that there was moderate level of fear perceived among the study participants for dental treatments. There was no age or gender difference in that which was in contrast to Shirahmadi et al.[2] as in those females, youngsters, less previous work experience, and dental hygienists were more motivated to control their fears than other groups. Similar results were noted by Wilson and Byers[7] and Raybould et al.[8] Literature showed that the most important influencing source on efficacy is past experience.[9] Therefore, previous experience of dealing with various epidemics, including influenza and infectious diseases such as AIDS and hepatitis, can increase the efficacy of providers as well as consumers to combat the same but that point was not included in the current study.[6]

The pattern of use of PPEs was very essential. This indicated a more positive effect of the perceived efficacy than the perceived threat dimension on the recommended health behaviors in order to intervene and provide guidance. This was similar to Shirahmadi et al.[2] The results of Israel study also showed that lower psychological distress was associated with having higher scores for self-efficacy[10] and not utilizing the dental care during pandemic similar to Hua et al.[11] and Mahdee et al.[12]

The reason for this can be that their perceived response efficacy as 95% of the participants considered the recommended health behaviors to be effective in preventing the transmission of the disease and perceived their ability as high to perform the preventive behaviors, which was similar to the Shirahmadi et al.[2]

CONCLUSION

The fear of dental treatment during pandemic in the current study was moderate. This may be due to the self-care and positive behavior toward oral care by the people due to the awareness. However, fear of cross contamination due to airborne infections should not be neglected even in presence personal protective measures. All this is leading to paradigm shift in the change in health care delivery. Infection control practices have become a necessity and paramount in reducing the anxiety and fear due to the pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.